Notice
Monday, January 20: Our Customer Service line (800-452-9310) will be closed in observance of Martin Luther King Jr. Day. Accounts with dedicated customer service numbers can still call between 9:00 AM and 5:00 PM ET, but may experience longer wait times. We apologize for any inconvenience this may cause.
Need benefit information and claim status in a hurry? The MySmile self-service website and Interactive Voice Response system (800-452-9310) are available 24/7.
Change Healthcare announced a breach of HIPAA privacy and is reaching out to individuals whose personal information may have been compromised. Although this incident does not involve Delta Dental of New Jersey or Connecticut, Change Healthcare is a vendor we used and we are providing this information to help our members who might be affected.
Small Group Forms for Brokers
Easily access and download all the small group forms and applications.
Small Business Dental Plan Forms for 2-50 Enrolled Employees
Easy employer application (PDF, 9 pages, 1,930 KB)
Download our easy group application for 2-50 business
Simple dental employee enrollment (PDF, 1 page, 204 KB)
Download our easy dental group enrollment form for 2-50 business
Simple vision employee enrollment (PDF, 1 page, 204 KB)
Download our easy vision group enrollment form for 2-50 business
Enrollment spreadsheet (Excel)
Download our easy group enrollment spreadsheet guide for 2-50 business
Delta Dental of New Jersey is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
